EP16 – Window resection for intraluminal cricotracheal invasion by papillary thyroid carcinoma

      Sueyoshi Moritani1; Masao Takenob1; Kana Yoshioka1; Tuyoshi Morisaki1; Kunihiko Nagahra1 1 Center for Head and Neck Surgery, Kusatsu General Hospital, Japan Background: Invasion of the upper aerodigestive tract by papillary thyroid carcinoma (PTC) affects both prognosis and quality of life. We assessed the efficacy of window resection for patients with intraluminal cricotracheal invasion. Methods: Clinical data were retrospectively reviewed for all patients with PTC undergoing surgery at our institution during 1981–2009. Seventy-six patients with intraluminal cricotracheal invasion were enrolled, including 34 relapsing patients. Results: The 10-year disease-specific survival rate of 42 patients with intraluminal invasion who underwent initial surgery was 60.8%. The lesion was located on the laryngo-trachea in 3 (4%) of 12 patients with locoregional recurrence. No major surgical complications were associated with cricotracheal resection. Stomal closure was achieved in 30 of 76 patients (39%). Twelve patients (16%) had a permanent stoma that was directly related to cricotracheal invasion. Their stomas had been caused by large cricotracheal defects with greater than or equal to 50% circumferential resection of the trachea. Sixty-seven patients (88%) had PTC invasion into other aerodigestive structures, including the recurrent laryngeal nerve (n = 54), esophagus (n = 38), and thyroid cartilage or intraluminal invasion of the larynx (laryngeal invasion, n = 23). Multivariate analysis showed that cricotracheal invasion accompanied by recurrent laryngeal nerve invasion was predictive of permanent stoma (odds ratio, 0.32; 95% confidence interval, 0.107–0.945; p = 0.039). Conclusion: Window resection appears to be an effective treatment option for patients with intraluminal cricotracheal invasion. However, this surgical technique may be inappropriate for the treatment of large cricotracheal defects without a supportive hard structure. References:
    1. Park CS, Suh KW, Min JS (1993) Cartilage-shaving procedure for the control of tracheal cartilage invasion by thyroid carcinoma. Head Neck 15:289–291
    2. Nishida T, Nakao K, Hamaji M (1997) Differentiated thyroid carcinoma with airway invasion: indication for tracheal resection based on the extent of cancer invasion. J Thorac Cardiovasc Sur 114:84–92
    3. Honings J, Stephen AE, Marres HA et al (2010) The management of thyroid carcinoma invading the larynx or trachea. Laryngoscope 120:682–689
    4. Haugen BR, Alexander EK, Bible KC, et al (2016) 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 26:1–133
    5. Shindo ML1, Caruana SM, Kandil E et al (2014) Management of invasive well-differentiated thyroid cancer: an American Head and Neck Society consensus statement. AHNS consensus statement. Head Neck 36:1379–1390
    6. Czaja JM, McCaffrey TV (1997) The surgical management of laryngotrachealinvasion by well-differentiated papillary thyroid carcinoma. Arch Otolaryngol Head Neck Surg 123:484–490
    7. Ishihara T, Kobayashi K, Kikuchi K (1991) Surgical treatment of advanced thyroid carcinoma invading the trachea. J Thorac Cardiovasc Surg 102:717–720
    8. Shadmehr MB, Farzanegan R, Zangi M et al (2012) Thyroid cancers with laryngotracheal invasion. Eur J Cardiothorac Surg 41:635–40
    9. Wada N, Nakayama H, Masudo Y et al (2006) Clinical outcome of different modes of resection in papillary thyroid carcinomas with laryngotracheal invasion. Langenbecks Arch Surg 391:545–549
    10. Ito Y, Fukushima M, Yabuta T et al (2009) Local prognosis of patients with papillary thyroid carcinoma who were intra-operatively diagnosed as having minimal invasion of the trachea: a 17-year experience in a single institute. Asian J Surg 32:102–108
    11. Tsukahara K, Sugitani I, Kawabata K (2009) Surgical management of tracheal shaving for papillary thyroid carcinoma with tracheal invasion. Acta Otolaryngol 129:1498–1502
    12. McCarty TM, Kuhn JA, Williams WL Jr et al (1997) Surgical management of thyroid cancer invading the airway. Ann Surg Oncol 4:403–408
    13. Tsai YF, Tseng YL, Wu MH et al (2005) Aggressive resection of the airway invaded by thyroid carcinoma. Br J Surg 92:1382–1387
    14. Gaissert HA, Honings J, Grillo HC et al (2007) Segmental laryngotracheal and tracheal resection for invasive thyroid carcinoma. Ann Thorac Surgery 83:1952–1959
    15. Musholt TJ, Musholt PB, Behrend M et al (1999) Invasive differentiated thyroid carcinoma: tracheal resection and reconstruction procedures in the hands of the endocrine surgeon. Surgery 126:1078–1088
    16. Ebihara M, Kishimoto S, Hayashi R et al (2011) Window resection of the trachea and secondary reconstruction for invasion by differentiated thyroid carcinoma. Auris Nasus Larynx 38:271–275
    17. Ozaki O, Sugino K, Mimura T et al (1995) Surgery for patients with thyroid carcinoma invading the trachea: circumferential sleeve resection followed by end-to-end anastomosis. Surgery 117:268–271
    18. Nakao K, Kurozumi K, Nakamura M et al (2004) Resection and reconstruction of the airway in patients with advanced thyroid cancer. World J Surg 28:1204–1206
    19. Moritani S (2015) Surgical management of cotracheal invasion by papillary thyroid carcinoma. Ann Surg Oncol 22:4002–4007
    20. Schwartz DL, Lobo MJ, Ang KK et al (2009) Postoperative external beam radiotherapy for differentiated thyroid cancer: outcomes and morbidity with conformal treatment. Int J Radiat Biol Phys 74(4):1083–1091
    21. Vassilopoulou-Sellin R, Schultz PN, Haynie TP (1996) Clinical outcome of patients with papillary thyroid carcinoma who have recurrence after initial radioactive iodine therapy. Cancer 78:493–501


Leave a Reply